Biopsy In Women Research Articles

Prediction of cervical intraepithelial neoplasia grade 2–3 using risk assessment and human papillomavirus testing in women with atypia on papanicolaou smears

Objective: To determine whether human papillomavirus (HPV) DNA testing and risk assessment can predict cervical intraepithelial neoplasia (CIN) 2–3 on biopsies in women with atypia on Papanicolaou smears. Methods: One hundred ninety-five consenting women were referred for colposcopy because of atypia on Papanicolaou smears between September 1997 and April 1999. Before colposcopy, women completed risk assessments and had cervical swabs collected for HPV testing using the Hybrid Capture-II assay (Digene Corporation, Silver Spring, MD). Associations of demographic and clinical variables were assessed by χ 2 analysis, and logistic regression was used to assess factors associated with CIN 2–3. The cost-effectiveness of routine colposcopy versus reflex HPV testing by either conventional or liquid-based Papanicolaou smear media was compared. Results: Cervical intraepithelial neoplasia was diagnosed in 70 of 195 women (35.9%), 55 (28.2%) with CIN 1 and 15 (7.7%) with CIN 2–3. High-risk HPV types were detected in 31.3% of all subjects, 36.4% of those with CIN 1, and 93.3% of those with CIN 2–3. By logistic regression, CIN 2–3 was associated only with detection of high-risk HPV (odds ratio 110.08, 95% confidence interval 8.35, 999.00). The sensitivity of high-risk HPV for detecting CIN 2–3 was 93.3%, specificity 73.9%, positive predictive value 23.0%, and negative predictive value 99.3%. The cost of reflex HPV testing using conventional smear or liquid-based media was less than routine colposcopy ($4809 and $4308, respectively, versus $4875 per case detected). Conclusions: Triage based on HPV testing would result in referral of approximately 31% of patients to colposcopy and appears to be a sensitive and cost-effective alternative to colposcopy.

Risk Categories for Abnormal Endometrial Biopsy in Dysfunctional Uterine Bleeding

Objective: this study was designed to examine the clinical utility of risk factors for postmenopausal endometrial adenocarcinoma in predicting abnormal endometrial biopsy in premenopausal women diagnosed with dysfunctional uterine bleeding (DUB). The second purpose was to develop risk categories for abnormal endometrial biopsy in women with DUB.Design: prospective observational study.Setting: gynaecology department of a large teaching hospital.Population: women complaining of premenopausal abnormal gynaecological bleeding.Methods: women were included in the study if they experienced abnormal gynaecological bleeding due to either DUB or small fibroids. The risk factors for endometrial cancer that were tested included menstrual cycle irregularity, diabetes, nulliparity, hypertension, obesity (weight ≥ 100 kilograms or Body Mass Index > 33) and age ≥ 40 years. Logistic regression was used to investigate the relative importance of each risk factor.Main outcome measures : the correlation of abnormal endometrial histology with risk factors for endometrial cancer.Results: six hundred women were studied. Sixty-nine patients were excluded. The results from 531 patients with either DUB alone (467) or bleeding associated with small fibroids (64) were analysed. Thirty-four (6.4%) patients had abnormal endometrial biopsies. Menstrual cycle irregularity was the only statistically significant independent risk factor for an abnormal biopsy. No specific subtype of irregular menstrual pattern predicted an increased prevalence of abnormal endometrial biopsy.Conclusions: premenopausal women diagnosed with DUB whose menstrual cycles are regular have a negligible risk of developing endometrial hyperplasia, and can safely be spared the discomfort and risk of complications associated with endometrial biopsy.

Screening before and during the use of oral contraceptives and hormone replacement therapy. The ESHRE Capri Workshop Group.

Most users of oral contraceptives (OC), and many users of hormone replacement therapy (HRT) are apparently healthy, using a preparation for preventative purposes. It is understandable, therefore, that many clinicians feel that they should screen women using these preparations for hidden disease. Sometimes this has resulted in women being subjected to a variety of procedures. This medicalization of the provision of care can inhibit women from availing themselves of these services. All screening programmes must have evidence that: early detection will affect the natural history of the disease; the performance characteristics of the test must be known; the test should be cost-effective, acceptable to users and providers, should influence clinical decisions, and treatment should exist for abnormal results. The tests time to time suggested before and during the use of OC and HRT do not fulfill these needs. Whether any of the contraindications for OC use are present can be determined simply by taking a history and performing a physical examination including measurement of blood pressure. The same policy applies to the women who will start HRT. If facilities are available for screening mammography this test should be performed prior to starting HRT as the oestrogen can promote the growth of an existing subclinical breast cancer. It is not cost effective to perform an endometrial biopsy in women without abnormal genital bleeding prior to starting HRT. Routine measurement of bone density is also not cost effective or necessary since no current available agent reduces the risk of fractures in women with osteoporosis more than HRT.

Sentinel lymph node biopsy after percutaneous diagnosis of nonpalpable breast cancer.

To determine the technical success rate of sentinel lymph node biopsy in women with nonpalpable infiltrating breast cancer diagnosed by using percutaneous core biopsy and to determine the frequency with which sentinel lymph node biopsy obviated axillary dissection. Retrospective review revealed 33 women who underwent sentinel node biopsy after percutaneous core biopsy diagnosis of nonpalpable infiltrating breast cancer. Sentinel nodes were identified with radioisotope and blue dye; the procedure was technically successful if sentinel nodes were found at surgery. All sentinel nodes were excised. Axillary dissection was performed if tumor was present in sentinel nodes. Sentinel nodes were found at surgery in 30 women (91%). Sentinel nodes were identified with both radioisotope and blue dye in 22 (73%) of these women, with only radioisotope in six (20%), and with only blue dye in two (7%). Sentinel nodes were found in 12 (80%) of 15 women in the first half of the study versus all 18 (100%) women in the second half (P = .08). Sentinel nodes were free of tumor in 23 (77%) of 30 women. In six (86%) of seven women with tumor in sentinel nodes, the sentinel nodes were the only nodes with tumor. Sentinel node biopsy was successful in 30 women (91%) with nonpalpable infiltrating carcinoma diagnosed with percutaneous core biopsy and obviated axillary dissection in 23 women (70%). Using both radioisotope and blue dye may increase the success rate. A learning curve exists, and success improves with experience.

O-133. Skin biopsy in women with recurrent fetal loss: a method of diagnosing the presence of antiphospholipid antibodies?

O-133. Skin biopsy in women with recurrent fetal loss: a method of diagnosing the presence of antiphospholipid antibodies?

A prospective randomized double‐blind placebo‐controlled study of local anaesthetic injected through the hysteroscope for outpatient hysteroscopy and endometrial biopsy

ObjectiveTo determine whether the injection of local anaesthetic through the hysteroscope at outpatient hysteroscopy, with or without endometrial biopsy, will reduce abdominal pain and increase patient acceptability of the two procedures.DesignProspective randomized double‐blind placebo‐controlled study.SettingOutpatient hysteroscopy clinic, Royal Hospital for Women, Sydney, Australia.Subjects100 women undergoing outpatient hysteroscopy with or without endometrial biopsy.InterventionsRandomization into two groups: local anaesthetic (group 1) and placebo (group 2). Upon introduction of the hysteroscope into the cervical os, 5 ml of 2% plain lignocaine (group 1) or normal saline (group 2) was introduced via the channel in the hysteroscope. After 2 min, the hysteroscopy and endometrial biopsy (where indicated) were conducted in the usual manner.Main outcome measuresThe degree of pain experienced and the acceptability of the procedures were assessed using visual analogue scales.Results99 women underwent hysteroscopy (49 in group 1 and 50 in group 2) with 92 also undergoing endometrial biopsy (45 in group 1 and 47 in group 2) Both groups were homogeneous for age, parity, menopausal status and subjective pain tolerance assessment. Group 1 found both the hysteroscopy and endometrial biopsy to be less painful and more acceptable, but these differences were not statistically significant. Four subgroups were analysed: nulliparous (group A), no past vaginal delivery (group B), postmenopausal (group C), and no previous dilatation and curettage (group D). Local anaesthetic reduced the pain at hysteroscopy in groups A, B and C and at endometrial biopsy in all groups, with groups B, C, and D at endometrial biopsy reaching statistical significance (P = 0.05, 0.03, and 0.04, respectively).ConclusionsTopical intra‐uterine anaesthetic injected through the hysteroscope results in: (1) a trend towards a reduction in pain for both hysteroscopy and endometrial biopsy, and (2) a significant reduction in pain during endometrial biopsy in women who have not had a previous vaginal delivery, or dilatation and curettage, or are postmenopausal.

P-49. Accuracy of Ambulatorial Hysteroscopy Associated to Endometrium Biopsy in Women with Postmenopausal Bleeding

P-49. Accuracy of Ambulatorial Hysteroscopy Associated to Endometrium Biopsy in Women with Postmenopausal Bleeding

Likelihood ratios for clinical examination, mammography, ultrasound and fine needle biopsy in women with breast problems

Abstract Instead of the conventionally used sensitivity and specificity, we present likelihood ratios (LRs) as a better measure of the accuracy of clinical examination, mammography, ultrasound and fine needle aspiration cytology in women presenting with breast problems. In addition, we point out that previous studies are prone to verification bias in the selection of subjects, and demonstrate methods of avoiding this problem. Both issues are illustrated using a dataset consisting of 7259 women who attended the Sydney-Square Breast Clinic consecutively in 194, of whom 375 had surgical biopsy and 145 were found to have malignancy. Information on the non-cancer group was based on all women with a benign outcome on surgical biopsy and, to avoid verification bias, a sample of 232 subjects chosen randomly from consecutive attenders. LRs for five levels of each test, categorized from normal to malignant, ranged from 0.43 to 46.41 for clinical examination, from 0.18 to ∞ for mammography, from 0.17 to ∞ for ultrasound, and from 0.009 to ∞ for cytology. LRs calculated using only subjects with a benign outcome on histology differed appreciably from those calculated using the more appropriate random sample of all non-cancers. Future researchers need to avoid verification bias in studies of test accuracy by including a random sample of consecutive subjects rather than only those who proceed to histology. LRs have an advantage over sensitivity and specificity because they provide a measure of test accuracy which allows test results to be reported as several categories. In clinical practice, these LRs are easy to use to calculate the probability of cancer.

Atypical hyperplasia in the era of stereotactic core needle biopsy

Background and Objectives: To characterize both atypical hyperplasia (AH) and the malignancies typically present at open surgical biopsy in women diagnosed with AH by stereotactic core needle biopsy (SCNB). Methods Patients with AH diagnosed by SCNB were advised to undergo surgical biopsy to rule out an associated malignancy. Mammography findings, pathology reports and follow-up data were analyzed. Results AH was identified by SCNB in 38 of 893 (4.3%) patients. Carcinoma was identified in 12 of 33 (36.4%) patients who went on to surgical biopsy. Ductal carcinoma in situ (DCIS) was present in 11 of the 12 patients with malignancy. There were no characteristic mammographic findings which would identify patients with carcinoma. Conclusions When SCNB returns a diagnosis of AH there is a substantial risk of an associated malignancy in the breast. There appear to be no definitive criteria to distinguish which patients harbor a malignancy, and surgical biopsy should always serve as an adjunct diagnostic procedure. J. Surg. Oncol. 1998;67:168–173. Published 1998 Wiley-Liss, Inc.11 This article is a US Government work and, as such, is in the public domain in the United States of America.

Atypical hyperplasia in the era of stereotactic core needle biopsy.

To characterize both atypical hyperplasia (AH) and the malignancies typically present at open surgical biopsy in women diagnosed with AH by stereotactic core needle biopsy (SCNB). Patients with AH diagnosed by SCNB were advised to undergo surgical biopsy to rule out an associated malignancy. Mammography findings, pathology reports and follow-up data were analyzed. AH was identified by SCNB in 38 of 893 (4.3%) patients. Carcinoma was identified in 12 of 33 (36.4%) patients who went on to surgical biopsy. Ductal carcinoma in situ (DCIS) was present in 11 of the 12 patients with malignancy. There were no characteristic mammographic findings which would identify patients with carcinoma. When SCNB returns a diagnosis of AH there is a substantial risk of an associated malignancy in the breast. There appear to be no definitive criteria to distinguish which patients harbor a malignancy, and surgical biopsy should always serve as an adjunct diagnostic procedure.

Vaginal ultrasonography versus endometrial biopsy in women with postmenopausal bleeding

OBJECTIVE: Our goal was to compare the predicted outcomes and costs of two diagnostic algorithms for postmenopausal bleeding. STUDY DESIGN: Two algorithms for postmenopausal bleeding were developed, one with vaginal ultrasonography and the other with office endometrial biopsy as the first test. Literature review was performed to estimate the probability of either an abnormal result of ultrasonography or a nondiagnostic biopsy, or both. Cost and sensitivity analyses were performed. RESULTS: Estimated probability of a nondiagnostic endometrial biopsy was 28%, and estimated probability of an abnormal result of vaginal ultrasonography (either inconclusive or endometrial thickness >4 mm) was 55%. Cost analysis showed that vaginal ultrasonography as the first diagnostic test cost $230 per patient on average compared with $244 for endometrial biopsy, with savings ranging from $14 to $20 per patient over a wide range of possible values for estimated parameters. CONCLUSION: Vaginal ultrasonography costs slightly less than office endometrial biopsy as the first test in the diagnostic evaluation of women with postmenopausal bleeding. (Am J Obstet Gynecol 1997;177:924-9.)

Assessing the importance of endometrial biopsy prior to oocyte donation.

The importance of performing an endometrial biopsy in women preparing for oocyte donation goes beyond confirming the histologic response to hormone replacement therapy. Additional information related to uterine architecture, ease of embryo transfer, status of the ovaries, and patient compliance is also gained. Finally, the return visit provides an opportunity to discuss plans for the upcoming cycle. Whereas this report does not specifically address the question as to how many pregnancies were contingent upon the satisfactory performance of the mock cycle, we estimate that due to a combination of factors (i.e., lack of endometrial response, patient noncompliance, difficult embryo transfer), the likelihood of pregnancy in many cases would have been substantially reduced had the preliminary cycle not been attempted.

Ultrasound-guided biopsy of nonpalpable breast masses by surgeons.

Recently, ultrasound (US)-guided needle biopsy has been proposed as an acceptable alternative to open biopsy in women with nonpalpable breast masses. This study evaluated the accuracy of US-guided needle biopsy of nonpalpable breast masses performed by surgeons at the time of the initial clinical examination. Ultrasound-guided aspiration and/or core biopsy (US-GAB) was performed on 103 patients presenting with a nonpalpable, new, or increasing-size mass detected on mammography. Study patients included those whose US was classified as: fibroadenoma (FA) (n = 26), complex cyst (n = 32), indeterminate (complex cyst versus solid; N = 24), or suspect (n = 21). Of the 32 patients with diagnostic US of complex cyst, US-GAB confirmed 27 to be cysts. Twelve additional cysts were aspirated among the 24 indeterminate lesions. Sixteen FA were diagnosed on US-GAB; 11 of these underwent open biopsy and each was demonstrated to be a FA. Fibrocystic/benign-breast change (FBC) was diagnosed on 26 US-GAB; 15 of these underwent open biopsy, which demonstrated three FA and 12 FBC. Nine atypical lesions were diagnosed on US-GAB; six FBC, one papilloma, one FA, and one cancer were demonstrated on open biopsy. Seven cancers were diagnosed on US-GAB and all were confirmed on open biopsy. There were six insufficient specimens from US-GAB; four of these underwent open biopsy, which demonstrated two FA and two FBC. Ultrasound-guided aspiration and/or core biopsy performed by surgeons in conjunction with the initial clinical examination can accurately diagnose nonpalpable, mammographically detected breast masses.

Results of needle localized breast biopsy in women under age 50

The use of screening mammography in women aged 40 to 50 years is controversial because of a relative lack of data demonstrating survival benefit for this segment of the population. The charts of 809 consecutive women who underwent needle localized breast biopsy over a 6 1/2-year period were reviewed to determine the effect of age on the biopsy results. Patient ages ranged from 27 to 91 years (mean 56). Two hundred nineteen (27%) of the 809 needle localized breast biopsies were malignant, with a mean tumor diameter of 1.46 cm. This procedure identified malignancy in 3 (5%) of 60 patients age 40, and in 32 (15%) of 207 patients aged 40 to 49 years. Malignancy was significantly more likely in patients 50 years of age or older and was found in 184 (34%) of the 542 (P<0.001). Overall, 33% of all patients undergoing the procedure were under age 50. Without screening mammography, the diagnosis of breast cancer would have been delayed in 32 women aged 40 to 50, 15% of the total diagnosed with nonpalpable breast cancer in this study. We recommend the use of screening mammography in this age group.

Human papillomavirus detection by hybrid capture in paired cervicovaginal lavage and cervical biopsy specimens.

Infection of the uterine cervix with human papillomavirus (HPV) is associated with dysplastic lesions that may progress to malignancy. Certain HPV types are associated with higher risk of cervical cancer than other genital HPVs. The goal of this study was to determine if cells obtained by cervicovaginal lavage contain similar HPV types as paired cervical biopsy in women referred because of abnormal cervical cytology. Thirty-four paired lavage and biopsy samples were analyzed for HPV DNA by hybrid capture, using "low risk" (HPV types 6. 11, and related types and "high risk" group (HPV types 16, 18, and related types) HPV. HPV was detected in 24 lavage samples and 18 biopsies. High risk types were predominant. In 14 of 18 HPV-positive biopsies, the paired lavage was also positive for the same HPV group. Four biopsies were HPV-positive at low levels, and the paired lavage was HPV-negative. The mean viral copy numbers of the biopsies from patients with positive and negative lavage samples were 2.7 and 0.1, respectively (P = .02). Ten low level HPV infections were detected by lavage that were not detected by biopsy. HPV detection by hybrid capture in cells obtained by cervicovaginal lavage reflects the results of HPV testing in cervical biopsies.

Abnormal uterine bleeding with normal uterine fluid level of human decidua-associated protein 200 reflects normal endometrial histology.

In the current study, the uterine fluid level of human decidua-associated protein (hDP) 200 was measured in 80 women with abnormal uterine bleeding and normal histology. In 20 women the level of hDP200 was also correlated with the endometrial thickness measured by transvaginal ultrasonography. The results demonstrated the same distribution and similar levels of uterine fluid hDP200 throughout the menstrual cycle as in regularly cycling women, with no correlation between the levels of hDP200 and the endometrial thickness. Thus, the test for uterine fluid hDP200 could serve to discriminate between benign and pathological examinations of endometrial biopsies in women of reproductive age, women with abnormal uterine bleeding and benign conditions of the endometrium. Very low levels of hDP200 are indicative of endometrial hyperplasia or carcinoma.

Cancer risk factors for selecting cohorts for large-scale chemoprevention trials

Many anticipate that application of findings in molecular genetics will help to achieve greater precision in defining high-risk populations that may benefit from chemopreventive interventions. We must recognize, however, that genetic susceptibility, environmental factors, and complex gene-environment interactions are all likely to be risk determinants for most cancers. Cohort studies of twins and cancer indicate that having "identical" genes is generally not a very accurate predictor of cancer incidence. Data from twin studies support the suggestion that environmental factors such as tobacco use significantly influence cancer risk. The complexities of the genetic contribution to disease risk are exemplified by the development of Duchenne muscular dystrophy in only one of monozygotic twin girls, hypothesized to be the result of X chromosome inactivation, with the distribution patterns of the X chromosome being skewed to the female X in the manifesting twin and to the male X in the normal twin. Evidence from transgenic and genetic-environmental studies in animals support the possibility of genetic-environmental interactions. Calorie restriction modifies tumor expression in p53 knockout mice; a high-fat, low-calcium, low-vitamin D diet increases prepolyp hyperplasia formation in Apc-mutated mice; and calorie restriction early in life influences development of obesity in the genetically obese Zucker rat (fafa). Such environmental modulation of gene expression suggests that chemoprevention has the potential to reduce risk for both environmentally and genetically determined cancers. In view of the growing research efforts in chemoprevention, the NCI has developed a Prevention Trials Decision Network (PTDN) to formalize the evaluation and approval process for large-scale chemoprevention trials. The PTDN addresses large trial prioritization and the associated issues of minority recruitment and retention; identification and validation of biomarkers as intermediate endpoints for cancer; and chemopreventive agent selection and development. A comprehensive database is being established to support the PTDN's decision-making process and will help to determine which agents investigated in preclinical and early phase clinical trials should move to large-scale testing. Cohorts for large-scale chemoprevention trials include individuals who are determined to be at high risk as a result of genetic predisposition, carcinogenic exposure, or the presence of biomarkers indicative of increased risk. Current large-scale trials in well-defined, high-risk populations include the Breast Cancer Prevention Trial (tamoxifen), the Prostate Cancer Prevention Trial (finasteride), and the N-(4-hydroxyphenyl) retinamide (4-HPR) breast cancer prevention study being conducted in Milan. Biomarker studies will provide valuable information for refining the design and facilitating the implementation of future large-scale trials. For example, potential biomarkers are being assessed at biopsy in women with ductal carcinoma in situ (DCIS). The women are then randomized to either placebo, tamoxifen, 4-HPR, or tamoxifen plus 4-HPR for 2-4 weeks, at which time surgery is performed and the biomarkers reassessed to determine biomarker modulation by the interventions. For prostate cancer, modulation of prostatic intraepithelial neoplasia (PIN) by 4-HPR and difluoromethylornithine is being investigated; similar studies are being planned for oltipraz, dehydroepiandrosterone, and vitamin E plus selenomethionine. The validation of biomarkers as surrogate endpoints for cancer incidence in high-risk cohorts will allow more agents to be evaluated in shorter studies that use fewer subjects to achieve the desired statistical power.

The effects of gonadotrophin-releasing hormone agonists on iliac crest cancellous bone structure in women with endometriosis

The administration of gonadotrophin-releasing hormone (GnRH) analogs to premenopausal women causes hypoestrogenism and bone loss, but the effects on cancellous microstructure have not been determined. In this study we have assessed bone structure in transiliac biopsies obtained from women before and after treatment for endometriosis with GnRH analogs. Twenty-one premenopausal women were studied, paired biopsies being obtained in 13; five women received both GnRH analogs and Org OD 14 (Tibolone, Livial). Comparison of pre- and post-treatment biopsies in women treated only with GnRH analogs showed a reduction in indices related to connectivity (node-to-terminus ratio, node-to-loop strut length, p < 0.02) and increase in inversely related indices (terminus-to-terminus and node-to-terminus strut length, p < 0.03). No significant changes were seen in any of the structural indices in women receiving both GnRH and Org OD 14 therapy. Activation frequency and bone formation rate at tissue level increased in women treated with GnRH agonists alone, although this change was not statistically significant. Our results suggest that bone loss induced by GnRH analogs may be associated with adverse effects on cancellous microstructure which are unlikely to be reversed following cessation of therapy. Concurrent treatment with Org OD 14 appears to prevent these changes.

The Role of Chlamydia Trachomatis Infection in Female Infertility

The incidence of positive Chlamydia cultures in females undergoing laparoscopy for tubal patency is high. We advocate routine screening for Chlamydia infection in females with infertility. Of seventy-five patients undergoing laparoscopy for infertility, 49 grew Chlamydia on tissue culture of material from the cervix, an incidence of 65.3%. of these 49 cases, 33 (67.3%) had tubal blockage. In asymptomatic patients, 22 out of 50 had positive cultures from the cervix, an incidence of 44%. Peritoneal fluid culture was negative in all infertile patients. When compared to populations studied elsewhere, the incidence of Chlamydia appears to be high in our population and significantly higher in the infertile patients. In the management of infertility, pelvic inflammatory disease, and neonatal conjunctivitis, Chlamydia should be routinely investigated and treated.

Screening mammography: value in women 35-39 years old.

The value of screening mammography for detecting early breast cancer in younger women is not widely recognized. We review the results of screening mammography and of breast biopsies performed on the basis of mammographic findings in women 35-39 years old to determine the detection rate for breast cancer and the stage of breast cancers detected at mammographic screening in this age group. Computer-tabulated results of mammography in women 35-39 years old who participated in a mobile mammographic screening program during the 36-month period from January 1989 to December 1991 were retrospectively reviewed with a standardized data collection form. Pathology reports from biopsies recommended on the basis of screening mammograms or follow-up examinations (coned views/sonograms) also were reviewed. Data were compared with results of mammographic screenings and pathologic findings at biopsy in women 40-49 years old who participated in this screening program during the same period. A total of 5105 screening mammograms were obtained in women 35-39 years old. Of these, 4654 (91%) showed no abnormalities. Biopsy was recommended in 36 (< 1%). Eight biopsies showed carcinoma, intraductal in five and stage I infiltrating ductal in three. Mammograms showed calcifications in all cancers detected; two infiltrating cancers also had an associated mass. The number of breast cancers detected was 1.6 per 1000 screenings, comparable to our rate of 1.4 cancers per 1000 screenings in women 40-49 years old. Because the number of cancers detected was small, the 95% confidence interval for the ratio of detection rates was wide, ranging from 2.56:1 to 1:2.29. Early stage tumors in women 35-39 years old can be detected on mammograms. The breast cancer detection rate in women 35-39 years old was comparable to that for women in their forties in our population; however, our data do not exclude a more than twofold difference in detection rates between these two groups. These data should be considered in determining the value of mammographic screening in women 35-39 years old.